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A. When a worker's injury was caused by the worker's employer's negligence, and the claim is filed under Labor Code section 5500.5, a 3000-hour statutory cap applies to the employer's liability. If the 3000-hour cap applies to the case, the insurance company will pay up to 3000 hours of indemnity benefits. These benefits are paid for out of a special fund created by employers and insurance companies to compensate injured workers. You may not know whether the employer's insurance company paid a claim for your injury and benefits to date because the insurance company has a 12-month waiting period when a third party settles with the employer's insurance company. Insurance payments start with the payment in January or February after the claim is filed, and continue until the end of the year.
A. This section describes the medical treatments you may be required to attend to correct and rehabilitate your injury. You will be examined by your doctor if he or she needs to tell the insurance company about the cost of any future medical treatment. The insurance company will cover the expenses if it holds liability for your injury. The doctor may also recommend treatments that don't help your injury, but can be covered if you take them. The insurance company does not pay for treatments that don't help your injury.
A. Your medical treatment may also be covered by the appointment with your personal physician. If you have injuries that require treatment by your personal physician, you also will need to be examined by your personal physician. If your personal physician is having trouble getting reimbursed for your treatment, you can get help from a specialty medical organizations such as the Rockland Compensation Fund.
A. It is important to know that a QME is authorized to treat a specific type of injury. A QME can treat other kinds of injuries, but in order to do so the QME needs to be certified by the DWC Medical Unit. d2c66b5586